In 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law. This paper explores the implications of these new healthcare policies in the United States, given that a universal healthcare system has already being put in place. More specifically, it explores the question "Does the new 'universal healthcare' system bring with it obligations for citizens participating within the system to be more conscientious about their health and lifestyle choices? And if so, on what grounds?". I argue that individuals have strong social and moral obligations within a universal healthcare system to take the minimal provisions required for staying healthy (eating healthy, exercising, getting vaccinations, smoking cessation, and attending routine "check-ups" in order to not burden others with easily avoidable healthcare costs. These new obligations are grounded in the duty of fair play stemming from the fact that health insurance is a cooperative scheme. Furthermore this paper will show that when a universal healthcare scheme is in place, the healthcare resources become a 'common good' which is susceptible to a collective action problem known as 'the tragedy of the commons', and thus also give recommendations for its solution. The solutions that I endorse, although designed to address the free-rider problem recognized David Winkler, shows that Winkler's solution goes too far by indiscriminately punishing every unhealthy individual within a universal healthcare system. / Master of Arts

This thesis investigates whether variations in wait times for different medical specialties have a significant impact on the proportion of people who choose to opt out of the public insurance system in their country. Canada presents an interesting case study because it is one of the few nations with a single-payer system for all procedures covered by the public health system. As a result, leaving Canada is the equivalent of opting into the private system in other countries where socialized medicine is available side by side to a private market provider. The results provide some evidence of a positive relationship, but are somewhat sensitive to the chosen sample period.

Bakgrund Ungefär 200 miljoner kvinnor i 30 olika länder har blivit utsatta för könsstympning världen över. Prevalensen för ingreppet är vanligt förekommande i länder inom Afrika och Asien. På grund av den rådande globaliseringen kommer tillståndet vara något som hälso- och sjukvården i höginkomstländer kommer komma i kontakt med i allt större utsträckning. Könsstympningen delas in i fyra olika kategorier och kan ge både fysiska, psykiska och sociala efterföljder. Det är genom hälso- och sjukvården som nya fall av kvinnor som genomgått ingreppet upptäcks och det är därför viktigt att vårdpersonal har kunskap om ingreppet och dess konsekvenser. Syfte Syftet var att belysa kvinnors upplevelser av könsstympning. Metod Föreliggande studie är en icke-systematisk litteraturöversikt. De sammanslagna sökningarna resulterade i 618 träffar som gav artiklar av kvalitativ och kvantitativ studiedesign. Artiklarna söktes i databaserna PubMed och CINAHL med relevanta sökord och avgränsningar utifrån exklusions- och inklusionskriterier. Sökorden som användes var “circumcision, female”, “circumcision, female/psychology”, “female genital mutilation”, “perception”, “culture”, “universal healthcare”, “psychological trauma”, “experiences” och “beliefs”. Artiklarna analyserades i sin tur genom en integrerad analys. Resultat Resultatet visade på att kvinnorna upplever fysiska, psykologiska och sociala konsekvenser av ingreppet. De fysiska konsekvenserna var enbart negativa. De psykologiska konsekvenserna var till största delen negativa, med positiva inslag. De sociala konsekvenserna kunde vara positiva förutsatt att kvinnan var bosatt i ett land där ingreppet praktiseras. Vidare framkom att vårdpersonal uppfattas som antingen okunniga, okänsliga, eller osäkra vid vårdmötet. Slutsats De fysiska, psykologiska och sociala konsekvenser som kvinnlig könsstympning leder till är mångfaldiga och komplexa. Då kvinnans upplevelser av könsstympningen i hög grad visades variera ställs det höga krav på vårdens förmåga att anpassa bemötandet därefter. God kompetens hos sjukvårdspersonal inom behandling, kommunikation och kulturella skillnader samt kunskap om ingreppets konsekvenser är av stor vikt för att kunna bidra till ökad hälsa hos dessa kvinnor. / Background  Approximately 200 million women in 30 different countries has been subjected to female genital mutilation worldwide. The prevalence of the procedure is common in countries in Africa and Asia. Due to the current globalization, it will also be something that healthcare professionals in high-income countries will encounter to an increasing extent. The procedure is categorized into four different types which all may cause physical, psychological and social consequences. It is through health care that new cases of women who have undergone the procedure are discovered, which is why it is of high importance that healthcare staff have knowledge of the procedure and its consequences. Aim  The aim was to illustrate women´s experiences of genital mutilation. Method  The present study is a non-systematic literature review. The combined searches resulted in 618 hits that presented articles of qualitative and quantitative study design. The articles were searched in the databases PubMed and CINAHL with relevant keywords and delimitations based on exclusion and inclusion criteria. The keywords used were “circumcision, female”, “circumcision, female/psychology”, “female genital mutilation”, “perception”, “culture”, “universal healthcare”, “psychological trauma”, “experiences” and “beliefs”. The articles were analyzed through an integrated analysis. Result  The results showed that women experienced physical, psychological and social consequences of the genital mutilation. The physical consequences were only negative. The psychological consequences were mostly negative, with positive elements. The social consequences could be positive given that the women were living in a country whereas the procedure is commonly practiced. Furthermore, it emerged that care staff are perceived as either ignorant, insensitive, or insecure at the care meeting. Conclusion  The physical, psychological and social consequences which the procedure leads to are nuanced and complex. With the knowledge that women's experiences can vary greatly there is a demand on the healthcare´s ability to adapt its treatments accordingly. The treatment, communication and cultural competence of the care staff, as well as knowledge about all the consequences of the procedure, are therefore of great importance in order to be able to contribute to increased health in these women.

Passage of the Patient Protection and Affordable Care Act (PPACA) in 2010 prompted the question of how independent businesses may react to the employer mandate in the PPACA. The law is based on the theory of managed competition and it is more likely to affect businesses with fewer employees than to affect larger businesses that already offer health insurance. The purpose of this quantitative, pre-experimental study was to examine the strategic responses of independent retail business owners in Hillsborough County, Florida, regarding their perceptions of the employer mandate in the PPACA. Before 2014, there was a great deal of non-peer-reviewed literature in which researchers made predictions about the PPACA and independent business perceptions regarding the new law. To determine independent business owners' perceptions of and strategies for addressing the PPACA, a random sample of 309 independent retail businesses in Hillsborough County was invited by e-mail to participate in an online survey. The quantitative data were analyzed using descriptive statistics, t tests for hypothesis testing, and chi-square goodness-of-fit analyses to confirm the results without using means. None of the alternative hypotheses were supported, indicating that the PPACA may not have an adverse effect on job creation for independent retail businesses in Hillsborough County. The findings of this study can indirectly promote positive social change by communicating to independent business owners and individuals that healthcare insurance options exist. This question was important to academics and business professionals, because the strategies employed by business owners may affect job creation.

Esta tese pretende ampliar o objeto de análise da judicialização da saúde, ao situar a questão dentro do Sistema Único de Saúde (SUS). A partir do estudo sobre a integralidade da atenção e a universalidade de acesso, que tomamos como regras do sistema, procuramos identificar o mínimo existencial do direito à saúde, tanto no SUS como no caso concreto. Defendemos a tese de que a identificação do mínimo existencial do caso concreto e do sistema de saúde pode ser realizada por várias pessoas: pelo legislador, pelo administrador, pelos membros do Conselho de Saúde e da Conferência de Saúde, pelo médico que assiste o paciente. Vimos também que a discricionariedade do administrador quanto à escolha das prestações mínimas a serem implementadas é reduzida no que diz respeito à saúde. Uma vez identificado o mínimo existencial da saúde, esse direito deve ser satisfeito, não se admitindo qualquer restrição, pois essa é uma exigência do ordenamento jurídico, que tem como valor fonte a pessoa humana. Defendemos também a posição de que, diante da omissão do Legislativo e do Executivo na implementação do direito ao mínimo existencial, caberá ao Poder Executivo atuar para que sejam cumpridas as políticas públicas e atingidos os objetivos do Estado Democrático de Direito. / The objective of this thesis is to expand the analysis of the judicialization (or judicial control) of health by placing the issue within the scope of the Brazilian Universal Healthcare Program (SUS). From the study on comprehensive care and universal access, which we accept as being the general rule in health system, we try to identify the existential minimum of the right to health both in the Brazilian Universal Healthcare Program SUS and in the concrete cases. We defend that the identification of the existential minimum in concrete cases and in the health system can be done by several people: the lawmaker, the administrator, the members of Health Councils and Health Conferences, and the physician attending the patient. We also saw that the administrators discretion towards choosing the minimum services to be implemented is reduced when referring to health. Once the existential minimum for health is identified, this right must be fulfilled, with no restrictions, since this is demanded by the legal system, whose basic value is the individual person. We also defend the position that, in view of the omission of the Legislative and Executive branches in implementing the existential minimum, it will be responsibility of the Judicial branch to act so that public policies are met and objectives of the Democratic State ruled by the law are complied with.

Esta tese pretende ampliar o objeto de análise da judicialização da saúde, ao situar a questão dentro do Sistema Único de Saúde (SUS). A partir do estudo sobre a integralidade da atenção e a universalidade de acesso, que tomamos como regras do sistema, procuramos identificar o mínimo existencial do direito à saúde, tanto no SUS como no caso concreto. Defendemos a tese de que a identificação do mínimo existencial do caso concreto e do sistema de saúde pode ser realizada por várias pessoas: pelo legislador, pelo administrador, pelos membros do Conselho de Saúde e da Conferência de Saúde, pelo médico que assiste o paciente. Vimos também que a discricionariedade do administrador quanto à escolha das prestações mínimas a serem implementadas é reduzida no que diz respeito à saúde. Uma vez identificado o mínimo existencial da saúde, esse direito deve ser satisfeito, não se admitindo qualquer restrição, pois essa é uma exigência do ordenamento jurídico, que tem como valor fonte a pessoa humana. Defendemos também a posição de que, diante da omissão do Legislativo e do Executivo na implementação do direito ao mínimo existencial, caberá ao Poder Executivo atuar para que sejam cumpridas as políticas públicas e atingidos os objetivos do Estado Democrático de Direito. / The objective of this thesis is to expand the analysis of the judicialization (or judicial control) of health by placing the issue within the scope of the Brazilian Universal Healthcare Program (SUS). From the study on comprehensive care and universal access, which we accept as being the general rule in health system, we try to identify the existential minimum of the right to health both in the Brazilian Universal Healthcare Program SUS and in the concrete cases. We defend that the identification of the existential minimum in concrete cases and in the health system can be done by several people: the lawmaker, the administrator, the members of Health Councils and Health Conferences, and the physician attending the patient. We also saw that the administrators discretion towards choosing the minimum services to be implemented is reduced when referring to health. Once the existential minimum for health is identified, this right must be fulfilled, with no restrictions, since this is demanded by the legal system, whose basic value is the individual person. We also defend the position that, in view of the omission of the Legislative and Executive branches in implementing the existential minimum, it will be responsibility of the Judicial branch to act so that public policies are met and objectives of the Democratic State ruled by the law are complied with.